Official. Drinking alcohol leads to hangover

Hangovers offer rich pickings for complementary therapists. It’s the perfect fodder for alternative medicine. Give them an affliction almost completely characterised by a progressive recovery and they will be tumbling over themselves to offer ‘cures’. Staring bleary-eyed at the Sunday supplements the recommended homeopathic regime of nux vomica suddenly seem like a good idea. Rational individuals try to reason through the fog of hangover and decide to take one pill (sorry pillule – don’t want to sound too allopathic) and then wait 24 hours. Hangover cured. Personally, I’d like to see a decent double-blind RCT looking at homeopathic nux vomica versus a bacon butty.

A paper in Addiction this month looked at drinking in young Danes partying at a Bulgarian holiday resort. They used the Acute Hangover Scale (AHS) to measure how people felt the morning after.

The Acute Hangover Scale is a nine-item scale and the question areas are: experience of hangover, thirst, tiredness, headache, dizziness or faintness, nausea, stomach-ache, heart racing and loss of appetite. You score 0, 1, 4, or 7 for each item depending on whether you rate it as: none, mild, moderate or incapacitating. So maximum score is 63 and it was first tested in Swedish mariners and students. You have to admire the strong-stomached researchers that braved hungover sailors and students to get this scale validated.

Personally, I think the scale could be developed further – an Enhanced Acute Hangover Scale if you will. Suitable items worthy of inclusion might include: craving for fatty food; drunken dialling activities; sensation of gorilla having defaecated in mouth; severity of Miscellanous Drinking Injuries (MDI); and level of regret/guilt over sexual activity.

Overall, the incidence of hangover was 68% after drinking more than 12 standard units. Who are these people that can drink 6 pints and have no hangover? Nearly a third of the sample apparently. However, this is slightly deceptive as many reported milder symptoms but didn’t qualify as having an Official Hangover. The mean AHS score was around 16 for those drinking 12 standard units but they used a cut-off with those above the 90th centile in light drinkers (<7 units) then deemed to have an Official Hangover for the purposes of the research.

There were two main associations with hangover. No one will be surprised to learn that hangover worsened the more the young Danes drank and you can be forgiven for suspecting this paper could lapse into an exercise in Stating the Bleeding Obvious. More interestingly, the severity of hangover increased significantly during a week of heavy drinking. Hangovers clearly got worse over the course of the week for the same drinking the night before. There was also no association with prior drinking habits.

There is a serious side to the paper. The reason that the hangover merits some serious research hinges around the exploration of the development of alcohol dependence. Consider this – do hangovers worsen with repeated exposure to alcohol? If they did, one theory suggests that hangovers are an ‘early and mild form of the alcohol withdrawal syndrome’. One that could later develop into a full blown withdrawal syndrome and this paper offers support to that theory. There may not yet be a clear clinical lesson here but it could have implications in the future when it comes to identifying drinkers at high risk of dependence.

Hesse, M., & Tutenges, S. (2010). Predictors of hangover during a week of heavy drinking on holiday Addiction, 105 (3), 476-483 DOI: 10.1111/j.1360-0443.2009.02816.x